Cystoscope



April14, 1942.

w. MEYERHOF ET A1.

CYS TOS COPE I Filed May 8, 1941 Patented Apr. 14, 1942 Unir oYsToscoPE v Wilhelm Meyerhof, and Mario' TrabulsL., Sao

Paulo, Brazil, assignors to the firm Asclepio- Mira Limitada, Sao Paulo, Brazil Application May 8, 1941, Serial-No. 392,472

In Brazil October 26, 1340 claims. (c1. 12s-f7) This invention relates rto improvements in cystoscopes, i. e. devices for introducing light and operating instruments into the bladder to per-- mit of ocular examination and treatment of the same.

It is one object of our invention to provide a cystoscope allowing examination, and surgical and therapeutical treatment of the bladder in every direction without the need of turning the cystoscope in the urethra of the'patient, and without doing harm to or needing the aid of the patient, the operator having complete control over the instruments used.

A further object of our invention is to provide in a cystoscope immobility to the desired degree of the irrigating and water outlet tubes and the electric leads.

It is also an object of our invention to provide a cystoscope allowing lateral movement of the instruments, and the possibility of marking eX- actly the spot of an observed process so that at subsequent seatings this spot may be found, even by another physician, without the necessity of further explorations. l

Other objects and advantages will appear from the following specication and the drawing forming a part thereof.

The cystoscopes hitherto used consist of two main parts, i. e. the sheath and the optical system to be introduced into the sheath. The sheath consists of a metallic round tube of oval or other suitable shape. It has at its terminal a lighting lamp and an opening for the issue of the operating instruments and for observations. At itsl initial part it has a handle provided with water inlet and outlet cocks, and means for attaching the electrical leads and the optical system. The optical system to be introduced into the sheath is provided, at the distal part near the objective lens, with a lever which can be moved by two knobs near the ocular. On a higher level. openings are provided for the entry of operating instruments which pass alongside through the sheath and come out at the terminal opening thereof.

In order to perform a cystoscopy,the cystoscope, i. e. the assembly constituted by the sheath and the optical system, is introduced by the physician into the patients urethra; this having been done, the beak of the cystoscope is located within the bladder, while its body is in Contact with the membrane of the urethra, and the handle and the ocular are outside. As mentioned above, the beak of the cystoscope has an opening which allows the vision. It is, however,

clear that' only those parts of the bladder, which` lie in the direction of said opening, can be seen, and that in order to perform a complete cystos'copy, inside the urethra, a series of successive'v y turning movements of thecystoscope mustbe carried out,y thereby changing the direction off the opening of the'cystoscope so that various parts of the bladder may be observed o-r treailedLL` Said movements cause traumatism inthe urethra.

The visual angle of the telescope has a diameter of about 25 and in order to observe a proc*- ess under water having an extension of 10v square centimeters or more, the physician must perform` a continuous rotating movement of they instruf ment in order to estimate the exte'msion'of` the observed process. During this rotating move-- ment, the water inlet and outlet rubberk tubes' and the electric leads entangle and trouble greatly the operator and annoy the patient. Ii dur-f ing the cystoscopical examination some. process:- isfound, the physician will note on the filing card? of the patient according to the usual method that" the process is located at 3 oclock. In making? such note, the physician calculates, on the basis of his experience, the direction of the openingl of the cystoscope, having in mind the Adial of` a timepiece, because he has not other means tol exactly identify the observed spot and to findo'utV v the depth at which the opening is to be 'fo-und At the next seating, during which the surgical or therapeutical treatment of the observed proc-1 ess is performed or continued, the physician will; try, again on the basis of his experience, to place the cystoscope in the direction noted on the filing card.Y In themajority vof cases, the exactv direction desired cannot. be found, and,'there.' fore, the physician must search again. I l

In order to vperform the coagulation of a papil loma or the catheterism of the ureter, thephysician introduces the tted instruments through: the openings. As the cystoscope allows him only the movement in the direction of the introduction of the instrument, While the deflecto'r or lid-al.- lows only the movement from above downwards, whenthe instrument insinuates itself at the. side of the process under treatment, the physicianmust perform again semi-circular movements of the instrument, because the cystoscope does not2 allow him to make lateral movements, si

The above mentioned difficulties can be overcome by the use of an improved cystoscopeac-lV cording to our present invention, a preferred em-i bodiment of which is described in the following, speclcation andthe accompanying drawing,` ini which AkFig. 1 shows the cystoscope assembly without part I of the handle; l

Fig. 2 shows the handle vseen from above;

2,279,714 f i l f number indicated by dash I5, in order to see at y what a depth the cystoscope nds itself, and the Fig. 3 is an enlarged longitudinal, sectional view of the handle formed by parts I and 2, the section being taken through line 3--3 of Fig. 2; Fig. 4 is a longitudinal sectional viewv of the rotating beak, and Fig. 5 is a vertical cross-section through the body of the cystoscope tube along line 5-5 o Fig. 4.

The cystoscope according to the invention sists of two main parts, the sheath and telescope. The Asheath comprisesthe `handle A, they body B and the beak C, and is formed by anin-l ternal and an external assembly. The handle VA is formed by 2 parts, ja-xe yexternal part I and a movable semi-internalfj ,A part 2. This movable part 2 is provided witha w dial I9 for the reading of the observed angle with'V tionof @theopening of the beak C.` Said fixed part I is provided with water inlet-andoutlet observation can be recorded on the filing card of the patient Vin an exactmanner. On performing another cystoscopical examination of the same patient, the physician will read the ling card and introduce the cystoscope until the depth marked, and he will direct the opening of the beak of the sheath to 2 oclock by reading the dial. Y l For the treatment of any process, suitable instruments may be introduced through the opening ci the beak, and when the instruments insinate, themselves at the side of the spot in reference to dash I5, or for indicating thedirec-f oo cks ,I 2,' and an electric contact generally deand is provided with twopins 29 to receive and` fixpart. I.'y The tubular body is Agraduated ,by the metrical or;any otherv system for the depth l measures.

Therot'ating beak has Va convex shape and.is provided with an opening 32 for the issue ofV instruments and for observation, Itv bears, the

chamber 33 -for the lighting lamp` 9. A reflect- -ing 'mirror 34 is tted beneath this lamp in order to; increase the intensity of the light. The beak is accurately set against the external tube 8V atw35, and is connected with the internal tube 1 by soldering at 36. The beakA whichrotates together with the internal tube 1, allows examination'and surgical treatment; of the bladderin anyy direction.- The'parts which' are in contact with the-urethra, need not vbe moved during cystoscopy,and allow also the lateral movement oLthe operating instruments. f f

' The internal assembly comprisesl part 2V of.the'

handle, the internal tube 1 ofthe body andthe beak which Vare -straightly connected with each other, while Athe externalassembly comprises part I of thehandle, `ands-the external tube IlV of the bodyv straightly connected therewith.

t The internal assembly is adapted to rotate independently from ythe external assembly. `If the internal assembly is caused to rotate, part..2`

of .the handle, `which is provided with the dial I9, `turns relative to part I of the handle,` whichk is provided witha reference dash I5, thus indi-L cating'by the observed angle the vdirection of the openingof the beak. f v l After the sheath has been introduced into:` the Vurethra of the patient, the external tube 8 rests1 in contact .Withthe urethral walls whiletherotating beak remains insidethe bladder. Since gsight, the, Vphysician may turn the beak towards the opposite side, having thus a lateral movev f nient of the instruments,

Theexternal assembly, and the cocks I2 and contact3 need not be moved during the cystoscopy.

Referring nowto the '-,details of the device shownby wayof example inthe accompanying drawing,Fig. 1 nshows the vassembly without external part-I of the, handle. Part 2 of the handle is connected with the internal tube 1 by soldering and tted at I1 against external tube `8, as shown in Fig. 3.2 Fig.` 1 also shows a contact ring `2|, insulating rings 20, water inlet apertures `I8,-- dial I9 and ring 5 for fastening the j telescope. Externaltube 8 is provided withrpins 29 for inserting part-I of the handle, which is xed by collar 3 I.; and is threaded at 30, as shown in Fig.`3. Y

Fig. 2 illustrates the complete handle provided with the dial ISL-"and it also shows the position:

of the cocks`I2.` A screw I3 is provided for nxing the rotating movement.

Fig. 3 shows" lthe assembly of the individual parts of thehandle and their connection with the 1' body of the instrument. Part I is inserted-into the terminal oflthe external tube 8 at the pins 29, and is-iixed byfc'ollar 3|. Screw I3 rests at I4 when it is screwed on in order to stop the `rotating movement. The electric contact 3 comprises a xing Apin 26 that pushes the spring 21 terminal ofthe external'tube 8. Thus, if part 2 the'movement ofthe beak isindependent from y the .externaltube 8, the physician can: turn Iit inevery direction without causing Ytraumatismf-toY the urethra. IIL-theprocess toi be observed 1s;

localized, it is sufficient to read on lthe dialth'ef `the invention .is not limited to the specic em'` bodiment presented herein for illustration, and ist susceptible of numerous modifications 'within` of the handle" caused to rotate, the internal tube] turns with it simultaneously. Fig. 3 alsor shows protecting'ring 25, and the insulating rings 20 of the contact ring 2|. The electric current is conducted to this ring 2| at any position-of the same, and it is transmitted tothe wire I I by the screw 22 passingthrough aperture'23, which ha alarger diameter than the screw.

shown in Fig. 4, the rotating `beak has a convex form, anda 'diameter which is equal to that .ofA the external tube 8; it is fastened against the latter at 35 and soldered on the internal tube 1 at thesurface 3E. Thus, the beak rotates together 4withginternal tubey 1 r.and with piece 2. The beak is -provided with an opening 32 for the issueof instruments andffor observation. The chamber 33 contains the lamp 9, socket I0, and the mrrorf34. Y

,will be evident from the above description,

the scope and spirit of the invention as defined in the appended claims.

We claim:

1. In a cystoscope, an internal assembly oomprising an internal tube connected with a tubular beak provided with an aperture for performing an endoscopy; an external assembly comprising an external tube concentrically surrounding said internal tube and having an outer diameterequal to that of said tubular beak; one end of said external tube being accurately set against and aligned with an adjacent end of said tubular beak; said internal assembly being capable of an independent rotating movement relative to said external assembly.

2. In a cystoscope, an external assembly comprising an external tube; an internal assembly comprising an internal tube'rotatably and concentrically arranged within, and tting into said external tube, and being soldered to a tubular beak which has an aperture for performing an endoscopy, an outer diameter equal to that of said external tube, and is accurately set against an end of, and aligned With said external tube; said internal assembly being capable of an independent rotating movement relative to said external assembly.

3. A cystoscope comprising a sheath which consists of an external assembly, and an internal assembly capable of being rotated independently from said external assembly; saidv sheath comprising a handle, a body, and a tubular beak; said body comprising an external tube and an internal tube which is rotatably and concentrically arranged within said external tube; said internal tube being rigidly connected With said tubular beak Which has an outer diameter equal to that of said external tube, and'is accurately set against an end of, and Aaligned with said external tube; said handle comprising an external part connected with an end of said external tube, and a semi-internal part connected with an end of said internal tube, and -capable of being assembly capable of being rotated independentlyv from said external assembly; said sheath comprising a handle, a body, and a tubular beak; said body comprising an external tube, and an internal tube rotatably and concentrically ar.-

yranged Within 'said external tube; said beak comprising a chamber for an electric' lamp, and a reflecting mirror, being provided with an opening for the issue of instruments and for observation,

having an outer diameter equal to thatv of said external tube, being soldered to an endof saidinternal tube, and iitted against and aligned with said external tube; said beak, due to its rotating movement, being adapted to aiord the lateral movement of the instruments.

5. In a cystoscope, a sheath comprising a handle, a body and 4a tubular beak having anopenf ing;'said handle -consisting of an external part and a semi-internal part capableof being rotated relative to said external part; said body being formed by an external tube and a concentrically arranged internal tube, which is rotatable within and independentlyfrom said external tube; one of the ends of said internal tube being connected to said semi-internal part of the handle and the other end of said internal tube being connected to the beak; one of the ends Vof said external tube serving for the insertion of saidexternal part of the handle andthe other` y end of said external tube terminating -against the beak; said beak having an outer diameter f equal to that of said external tube, being 'soldered to the adjacent end of said internal tube,v

accurately set against lthe end of and aligned with said external tube and rotatable together with said internal tube.

WILHELM MEYERHOF.

MARIO TRABULSI. y 

